Why has it all gone wrong for the Liberal Democrats?

Before they entered coalition with the Conservatives in 2010, the weeks ­running up to a general election used to be kind ones for the Liberal Democrats. Given some time in the media spotlight, their poll ratings would turn upwards like flowers in the spring.

This year, however, that pattern has not held. The Lib Dem leader, Tim Farron, is ­appearing on television and radio. Their policies are being covered in the national news. They are lucky in their opponents, too. On the right, there is a Conservative Party that has abandoned many of the liberal shibboleths it embraced under David Cameron and is fully committed to a hard exit from the European Union. And on the left there is a bitterly divided Labour Party led by Jeremy Corbyn.

Yet the long-awaited “Lib Dem revival” has stalled. The party lost 28 councillors across England and Wales in the local elections on 4 May, when it had expected to gain seats. The latest polls have the Lib Dems barely troubling double figures nationwide. According to YouGov, in the south-west of England, once a stronghold and where many of their former seats are located, the Lib Dems have increased their vote share by only 1 per cent since the 2015 general election. To make matters worse, the Conservatives – their main rival in the region – have increased their share of the vote at the expense of Ukip, which has collapsed.

The Liberal Democrats, who have only nine MPs, are gaining some votes, but mostly in areas where they cannot hope to dent thumping Labour and Conservative majorities. The one region where the party might hope to gain seats is in and around London, but even there, its strategists fear defeat in Carshalton and Wallington, where the Lib Dem chief whip, Tom Brake, faces an uphill battle to hold his seat.

Outside the capital, the Conservatives hope to gain North Norfolk from Norman Lamb, Farron’s rival for the party leadership, and are even more optimistic about taking Southport, where the 68-year-old sitting MP, John Pugh, has opted to stand down. The cold reality is that the Liberal Democrats have no safe seats – even Tim Farron could plausibly lose his own in Westmorland on a really bad night – and when an incumbent stands down, the party is particularly vulnerable.

Pugh’s retirement is also a blow to the party’s press office. At the start of the parliament, he was keen to increase his profile and he gave Lib Dem headquarters permission to use his name whenever it needed to respond quickly to events. That helped bolster the party’s reputation for speed, efficiency and an eye for a good gag, which has boosted its stock among political journalists. (The Lib Dem official Twitter feed offered a live commentary on Eurovision; not something the Conservatives would do.)

If the Lib Dems can make gains elsewhere (Cambridge and Twickenham spring to mind) they might come out of the election in no worse shape than they went into it. But that’s not the result their activists and strategists hoped only a few months ago, when they expected to ride an anti-Brexit wave. Just four days before Theresa May surprised Westminster with her decision to call the general election, Farron visited Manchester Gorton, a Labour stronghold since 1935. There he told journalists that he expected a strong second place in the by-election that had been planned following the death of Gerald Kaufman, and, perhaps, even to add a tenth MP to his flock. That optimism has now evaporated.

What went wrong? The obvious answer is that Farron bet heavily on casting the party in opposition to Brexit, and lost. That is a problem in seats such as Carshalton and North Norfolk, where a majority voted to leave the EU. The evidence suggests that few on either side of the referendum divide regret their decision, but since 23 June a distinct bloc has emerged. According to YouGov’s Marcus Roberts, formerly an adviser to Ed Miliband and Sadiq Khan, many Remain voters believe that Brexit is a calamity but accept that the government has a democratic duty to enact the referendum result. He calls them the “Re-Leavers”, and they are not at all receptive to the Liberal Democrat message of a second referendum.

Even more troubling for Farron is that the Lib Dems are not making headway among voters who want the vote for Brexit to be overturned. Although that’s a smaller group than the Re-Leavers, pollsters estimate that it accounts for close to 20 per cent of the electorate. So why aren’t these hard Remainers flocking to the yellow banner?

Part of the problem, simply put, is credibility. As one senior Liberal Democrat puts it, “voters can count”. No matter how angry you might be about the referendum result, it’s still a stretch to believe that nine Lib Dem MPs could prevent it. For Remainers who usually vote Labour, the prospect of undoing austerity with Jeremy Corbyn is more realistic than stopping Brexit. And Farron himself, though instrumental in driving through the decision to back a second referendum, is not a natural salesman for it. His evangelical Christianity, a repeated issue on the campaign trail, puts him at odds with the bulk of the diehard Remain vote, which tends to be aggressively secular. That Farron's voting record is not an immaculate advertisement for the separation of church and state only compounds that issue.

Among Conservative Remainers, the ­Liberal Democrats have another problem: the struggles of Labour. That might seem counterintuitive, but it reflects a widespread belief among voters that given a free choice, the Liberal Democrats will always opt to support Labour, rather than the Tories. If Labour is unappealing, then so is voting for anyone who might strike a deal with it to govern Britain. The former coalition minister David Laws, by no means a natural friend of Labour, has long argued that his party does best when Labour is strong and attractive to swing voters.

The fates of the two parties are thus intertwined. We saw that at the last general election when a weak Liberal Democrats, tainted by coalition, collapsed in the south-west and Scotland, delivering a Conservative majority. Now, it is Labour’s turn to toxify its fellow progressives. Corbyn’s troubles have not benefited Tim Farron: while voters fear a Labour Britain, they will not risk a Liberal England.

David had taken the same tablets for years. Why the sudden side effects?

David had been getting bouts of faintness and dizziness for the past week. He said it was exactly like the turns he used to get before he’d had his pacemaker inserted. A malfunctioning pacemaker didn’t sound too good, so I told him I’d pop in at lunchtime.

Everything was in good order. He was recovering from a nasty cough, though, so I wondered aloud if, at the age of 82, he might just be feeling weak from having fought that off. I suggested he let me know if things didn’t settle.

I imagined he would give it a week or two, but the following day there was another visit request. Apparently he’d had a further turn that morning. The carer hadn’t liked the look of him so she’d rung the surgery.

Once again, he was back to normal by the time I got there. I quizzed him further. The symptoms came on when he got up from the sofa, or if bending down for something, suggesting his blood pressure might be falling with the change in posture. I checked the medication listed in his notes: eight different drugs, at least two of which could cause that problem. But David had been taking the same tablets for years; why would he suddenly develop side effects now?

I thought I’d better establish if his blood pressure was dropping. I got him to stand, and measured it repeatedly over a period of several minutes. Not a hint of a fall. And nor did he now feel in the slightest bit unwell. I was stumped. David’s wife had been watching proceedings from her armchair. “Mind you,” she said, “it only happens mid-morning.”

The specific timing made me pause. I asked to see his tablets. David passed me a carrier bag of boxes. I went through them methodically, cross-referencing each one to his notes.

“Well, there’s your trouble,” I said, holding out a couple of the packets. One was emblazoned with the name “Diffundox”, the other “Prosurin”. “They’re actually the same thing.”

Every medication has two names, a brand name and a generic one – both Diffundox and Prosurin are brand names of a medication known generically as tamsulosin, which improves weak urinary flow in men with enlarged prostates. Doctors are encouraged to prescribe generically in almost all circumstances – if I put “tamsulosin” on a prescription, the pharmacist can supply the best value generic available at that time, but if I specify a brand name they’re obliged to dispense that particular one irrespective of cost.

Generic prescribing is good for the NHS drug budget, but it can be horribly confusing for patients. Long-term medication keeps changing its appearance – round white tablets one month, red ovals the next, with different packaging to boot. And while the box always has the generic name on it somewhere, it’s much less prominent than the brand name. With so many patients on multiple medications, all of which are subject to chopping and changing between generics, it’s no wonder mix-ups occur. Couple that with doctors forever stopping and starting drugs and adjusting doses, and you start to get some inkling of quite how much potential there is for error.

I said to David that, at some point the previous week, two different brands of tamsulosin must have found their way into his bag. They looked for all the world like different medications to him, with the result that he was inadvertently taking a double dose every morning. The postural drops in his blood pressure were making him distinctly unwell, but were wearing off after a few hours.

Even though I tried to explain things clearly, David looked baffled that I, an apparently sane and rational being, seemed to be suggesting that two self-evidently different tablets were somehow the same. The arcane world of drug pricing and generic substitution was clearly not something he had much interest in exploring. So, I pocketed one of the aberrant packets of pills, returned the rest, and told him he would feel much better the next day. I’m glad to say he did.